Upper Limb Tension Test 2 (ULTT2)

The Upper Limb Tension Test 2 (ULTT2) is a neurodynamic assessment used to test the mobility and sensitivity of peripheral nerves in the upper limb, particularly the median nerve, axillary nerve, and musculocutaneous nerve. ​​

It is part of the Upper Limb Tension Test series (ULTT1–4), which collectively help detect cervical radiculopathy, nerve entrapment, or adverse neural tension. Note, it is also known as the Elvey’s Test.

How the Test is Performed

  • Client position: Supine, with arms relaxed by their sides.​​

  • Therapist procedure:

    1. Depress the shoulder by gently but firmly stabilize it (often using the examiner’s hip) to prevent elevation.​​

    2. Abduct the shoulder to about 10°—less than ULTT1 (which uses 90°).​​

    3. Externally rotate the shoulder.

    4. Flex the elbow to about 90°.

    5. Supinate the forearm.

    6. Extend the wrist, fingers, and thumb.

    7. Slowly extend the elbow until the client reports symptom reproduction or tissue resistance.​​

    8. To confirm that symptoms are nerve-related, the therapist may side-bend the neck away from the tested side (which should increase symptoms), and then toward the tested side (which should ease symptoms).​​

  • A positive test:

    • Reproduction of the client’s familiar arm pain, tingling, or numbness along the distribution of the median, axillary, or musculocutaneous nerves.​​

    • Asymmetry or significant difference from the unaffected side.​​

Clinical Significance

  • ULTT2 is primarily used to evaluate median nerve tension, but biases additional involvement of the axillary and musculocutaneous nerves, unlike ULTT1 which isolates C5–C7 median branches.​​

  • Helps identify neurodynamic dysfunctions—cases where nerves or their surrounding tissues are restricted, irritated, or compressed.

  • A positive ULTT2 suggests possible:

    • Cervical radiculopathy (C5–C7)

    • Median nerve entrapment (at pronator teres or carpal tunnel)

    • Axillary or musculocutaneous nerve entrapment (proximal shoulder region).​​

  • Also aids in differentiating neural symptoms from muscular, fascial, or vascular causes.

Assessment

  • Use this test for clients with:

    • Neck, shoulder, arm, or hand pain

    • Numbness, tingling, or burning sensations

    • Postural compression or neural tension patterns

  • Document the side tested, movements performed, onset of tension/pain, distribution of symptoms, and any differences between sides.​​

Treatment

  • If positive:

    • Avoid deep or compressive massage along sensitive neural pathways (brachial plexus, anterior shoulder, forearm).

    • Apply gentle myofascial release and soft tissue mobilization techniques to surrounding structures to reduce external pressure on the nerves (e.g., scalenes, pectoralis minor, subscapularis, biceps brachii).

    • Introduce nerve gliding/flossing techniques only if approved and tolerated, focusing on restoring smooth neural mobility.

    • Provide posture and ergonomic education—especially for clients with forward head and rounded shoulder patterns, which can shorten anterior musculature and compromise nerve space.

Safety & Referral

  • Immediately refer for medical/physiotherapy evaluation if:

    • Symptoms progress or worsen during/after testing,

    • There’s persistent sensory loss or weakness,

    • Neurological red flags (numbness spreading, balance issues, or bilateral symptoms) are reported.

  • Avoid testing in clients with severe cervical pathology, recent nerve trauma, or acute inflammation